chpt 8 physical and chemical injuries Flashcards by David Lawlor

Common alteration of the buccal mucosa most often associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth, 13% of population

linea alba

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What is the clinical presentation of linea alba

white line, bilateral at level of occlusal plane with no other associated problems

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Linea alba treatment

None, no biopsy

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What causes linea alba

hyperkeratosis

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Lesion from chronic, habitual nibbling with a higher incidence in females presenting with thickend, shredded, white areas

Morsicatio Bucarum

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How would differentiat Morsicatio Buccarum from Luekoplakia from Lichen planus

Morsicatio bucarum has ragged torn look Leukoplakia has homogenous look Lichen Planus has Striae of Wickam

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What is chronic Lip chewing

Morsicatio Labiorum

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Chronic tongue chewing

Morsicatio Linguarum

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How could you differentiate Morsicatio Linguarum from Oral Hairy Leukoplakia

biopsy does not show EBV, candidiasis and no history of HIV

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Ways to get Ulcerations

1) Physical Thermal
2) Electrical
3) TUGSE
4) Riga-Fede disease

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What is TUGSE

Traumatic Ulcerative Granuloma with Stromal Eosinophilia

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With what is TUGSE associated

Eosinophils = allergies or parasites

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What is the only clinical differentiation between a TUGSE ulcer and an aphthous ulcer

TUGSE is slower to heal (>7 days)

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These are traumatic ulcerations of the ventral tongue in nursing babies and are a variation of TUGSE

Riga-Fede disease

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Represent 5% of all burn admissions

Electrical burns

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2 types of electrical burns and which is most common oral

Contact and Arc. Arc is most common orally with saliva acting as conductor

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Age and most common location for electric burns

<4 years old. Lips and commissures presenting charred yellow with little bleeding

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3 stages of treatment of ulcers (in order)

1.) Remove obvious injury
2.) Treat symptoms: cellulose films, topical
antibiotics, Orabase)
3.) If not healed in 2 weeks, Biopsy

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Are natal teeth associated with Riga-Fede disease extra teeth or are they the babies deciduous teeth simply erupted early

early erupted deciduous teeth.

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Sources of Chemical injuries

Aspirin OTC meds
Gasoline
Iatrogenic dental chemicals (formocreosol, etch,
Hydrogen peroxide, Silver nitrate)

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Why are OTC meds a source of chemical injuries

Have a lot of eugenol and phenol

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How can one get a cotton roll burn

either cotton roll wicks out moisture and causes necrosis, or holds caustic chemicals against the epithelium, or is removed and takes epithelium w/ it

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All systemic anticancer therapies (antineoplastic therapies) cause what

death of some normal cells

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What are the 2 acute oral changes associated w/ cancer chemotherapy

Mucocitis

Hemorrhage

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Where does oral mucocitis associated with cancer chemotherapy present

nonkeratinized surfaces (Buccal mucosa, ventrolateral tongue, soft palate, floor of mouth)

How does Oral Mucocitis associated with cancer chemotherapy and radiation treatment look clinically

early develops white discoloration from lack of keratin desquamation followed by loss of that layer & replacement by atrophic mucosa that is edematous, erythmatous & friable. Finally is ulcerated and covered by yellowish fibrinopurulent membrane

Where does Radition therapy acute mucocitis present

mucosal surface w/in direct portals of radiation

What are the 2 acute changes associated with cancer radiation therapy

Acute mucocitis | Dermatitis

What is the character of Radiation Therapy Dermatitis based on

Varies w/ amount received. Can be erythema, edema, burning, purities all the way to necrosis and deep ulcerations

What are the 5 Sequelae (a pathological condition resulting from disease [Wiki definition]) to Cancer Chemotherapy

- increased susceptibility to infection - Oral mucocitis - Oral ulceration - Increased risk of hemorrhage - Impaired healing

The introral hemorrhage that is a sequelae of cancer chemotherapy is secondary to what

thrombocytopenia caused by bone marrow suppression

This is a complication associated with head and neck radiation

Xerostomia

What is the course of radiation induced Xerostomia

changes after 1 week. Decrease in saliva after 6 weeks. Parotids dramatically/irreversibly affected. Decreased bactericidal activity of saliva cause increased caries

8 Sequelae of Radiation therapy

1) Hemorrhage 2) Mucocitis 3)Dermatitis 4) Xerostomia 5) Osteoradionecrosis 6) Loss of taste/ altered taste(Hypgeusia/dysguesia) 7) Trismus 8) Developmental anomalies (e.g. microdonts, hyloglossia) --> dependent on age and treatment

What can cause the osteoradionecrosis

hypoxia, hypovascularity, hypocellularity

What increases the risk of developing osteoradionecrosis and what are the treatment limits

Surgery. Do anything you can either 21 days prior to radiation (to allow healing prior to therapy) or wait 1 year after radiation therapy is complete

What can dentist do pretherapy for cancer patient

remove current or potential oral foci of infection. Give OHI

What can dentist do during cancer therapy (Intratherapy)

relieve pain, dehydration, malnutrition via admin of anesthetic, analgesics, antimicrobial, or coating agent

What can dentist do posttherapy for cancer patient

Topical fluoride, salivary substitutes, sugarless candies, infection prevention

What is the 1-2-3 Mouthwash

1/3 caopectate (coat mouth), 1/3 tetracycline (cut down on secondary infection), 1/3 benedryl (steroid to decrease inflammation)

Bisphosphonates are used to slow the osseous involvements of what diseases

cancer (multiple myeloma, metastatic breast or prostate) Paget’s disease Osteoporosis

When should elective surgical procedures be done on a patient who takes bisphosphonates

after discontinuance of drug and 3 month waiting period

Most cases of Bisphosphonate-Associated Osteonecrosis (BONJ) follow what type of bisphosphonate administration

IV use

What should one consider when pt is emaciated, agitated, nervous young adult with multiple Class V carious lesions

Methamphetamine abuse or trouble with VCU parking

Why worry about treating a patient that is high on methamphetamine

potentiates effects of sympathomimetic amines, so local w/ epi can lead to HTN crisis, cerevrovascular accident, myocardial infarction

Ulceration and Necrosis developing several days after local anesthesia due to tissue ischemia

Anesthetic Necrosis

Persistent scaling and flaking of the vermillion border, usually involving both lips associated with chronic habitual lip licking, biting, picking or sucking

Exfoliative Cheilitis

What is can be a sequelae of Exfoliative Cheilitis

bacterial or fungal infection (e.g. angular cheilitis)

Treatment of Exfoliative Cheilitis

psychotherapy/intervention for habit. Antibacterial/antimycotic/ steroid lip cream for angular cheilitis

2 causes of submucosal hemorrhage

Traumatic | Non-traumatic

Minute hemorrhages into skin, mucosa, or serosa

Petechiae

Slightly larger area than petechiae

Purpura

accumulation of boold within a tissue that produces a mass

Hematoma

3 causes of Non-Traumatic Submucosal Hemorrhage

1) Thrombocytopenia 2) Disseminated intravascular coagulopathy (DIC) 3) Viral infection (Mononucleosis [EBV, HHV-4], Measels [Rubeola])

Submucosal hemorrhage that is over 2 cm

ecchymosis

Patient has palatal erythema, petechiae or purpura, or lingual frenum tears or tongue ulcerations, part of the differential should include

oral sex (can use this as a clue for sexual abuse )

Incorporation of Amalgam into oral mucosa

Amalgam tattoo

4 ways to get an amalgam tattoo

1) mucosal abrasion containing amalgam 2) Amalgam fragments in extraction socket 3) Dental floss transfer 4) Endodontic retrofill procedures

If dark lesion along the gumline , but not evident on radiograph, what is required

Biopsy to differentiate from Melanoma

What is another means of getting oral localized exogenous pigmentation beyond an amalgam tattoo

- intentional tattooing - Pencil lead - Bullet fragments

What are the acute and chronic complications of Oral Piercings

acute: bleeding, infection, nerve damage. Chronic: speech impediment, nickel allergy, chipped teeth, aspiration

An oral piercing is an example of what type of injury

Factitial (self-inflicted)

6 systemic metallic intoxications

1) Lead/Plumbism 2) Mercury/Acrodynia 3) Silver/Argyria 4) Bismuth 5) Arsenic 6) Gold

Lead overdose is called what and has what oral manifestations

- PLUMBISM - Ulcerative stomatitis - Gingival lead line (BURTON'S LINE) - Metallic taste - Tongue tremor

Mercury overdose is called what and has what oral manifestations

- ACRODYNIA/pink disease/Swift disease - Hypersalivation - Ulcerative gingivitis - Bruxism/loss of teeth

Silver overdose is called what and has what oral manifestations and skin manifestations

- ARGYRIA - Slate blue gingival margins - Grayish skin discoloration

What is the line called associated w/ Plumbism and when is it seen

Burton’s line. Gingival inflammation as in gingivitis

Oral pigementation is increases significantly in what demographic

Smokers = SMOKER'S MELANOSIS

Pigmentary changes caused by polycyclic amines stimulating melanin by melanocytes is limited to what part of the mouth in Smoker’s Melanosis

Anterior Facial Gingiva

What gender is more sensitive to increased melanin pigmentation

Females

What drug can cause staining of the gingival as a result of the drugs deposition in the underlying bone

minocycline

Meds associated with Drug Related Discoloration of the Oral Mucosa

- phenolphthalein - Tranquilizers - Estrogen - AIDS meds - Minocycline - Antimalarials - Chemotherapeutics

Cartilage or bone discovered within soft tissue specimens removed from the oral cavity as the body’s way of reacting to constant irritation in an area (e.g. under denture on edentulous ridge)

Reactive Osseous and Chondromatous Metaplasia

How will Reactive Osseous and Chondromatous Metaplasia appear under a denture on the alveolar ridge

Extremely tender and localized area

What hobby/occupation is Reactive Osseuous and Chrondromatous Metaplasia common in, just not in the mouth

Equestrians on the inner thigh

Lesion that normally arises without patient knowing and in absence of trauma along the lingual surface of the mandible along the mylohyoid ridge, with the associated loff of the overlying oral mucosa

Spontaneous Sequestrations

These are commonly found on a panoramic as a dome-shaped faint radiopacity arising from the floor of the maxiallary sinus usually having an inflammatory exudates. It pushes the sinus epithelial lining up above it

Antral Pseudocyst

When have an increased prevalence of antral pseudocysts been noted

during winter months

What must be ruled out or treated as a cause of an antral pseudocyst

odontogenic infection

This is also in the maxillary sinus but it is an accumulation of mucin encased in epithelium

Sinus mucocelle

2 types of sinus mucocelles

1) Surgical Ciliated cyst | 2) Obstructed sinus ostium

Surgical ciliated cyst occurs when

portion of sinus linging gets separated from main body of sinus and forms epithelium lined cavity into which it secretes mucin

When the sinus ostium gets blocked, how is that sinus mucocelle formed

entire blocked sinus acts as an epithelium lined cyst and fills with mucin

These cysts arise from partial blockage of a duct of the sero-mucus glands or from an invagination of the respiratory epithelium and associated with antral polyps commonly

Retention Cysts

What is the character of a true sinus mucocelle(what will it do to bone and how will appear radiographically)

Will enlarge, expand bone and entire sinus will be cloudy on radiograph

Caused by the introduction of air into subcutaneous or fascial spaces of the face and neck. Air can come from blowing or sneezing after extraction or dentist blowing air into wound w/ air/water syringe or handpiece.

CERVICOFACIAL EMPHYSEMA

If the cervicofacial emphysema shows up hours after surgery, who is usually at fault

patient

Cervicofacial emphysema treatment

Broad Spectrum Antibiotic and warm compress

Radiographic radiolucency caused by dentist placing antibiotic in a petrolatum base into an extraction socket which will leave an asymptomatic circumscribed radiolucency looking like a residual cyst

MYOSPHERULOSIS

Myospherulosis treatment

Surgical excision

What can cervicofacial emphysema be confused with, and how can it be differentiated

confused with angioedema but cervicofacial emphysema will have crepitus in the swelling

chpt 8 physical and chemical injuries Flashcards

(91 cards)